Pharmacotherapy for Insomnia of the Elderly

ABSTRACT

Insomnia is a common disease in the elderly. It is caused by various etiologies and their combinations. Therefore, treatment should be tailored to the individual. Cognitive-behavioral therapy for insomnia (CBT-I) is the treatment of choice for chronic insomnia; however, hypnotics are commonly used as a primary treatment in the clinical practice. The hypnotics approved for insomnia management in Korea include zolpidem, eszopiclone, triazolam, doxepin, prolonged-release melatonin, and flurazepam. Although not approved, sedative antidepressants and antipsychotics are also frequently used. When prescribing hypnotics to elderly patients, the side effects and limitations of pharmacotherapy should be explained in advance, and the lowest effective dose and “as needed” prescription should be employed. Moreover, the adverse effects should be considered, including dependence, in the elderly. When reducing the medication dose, gradual tapering is safe and realistic considering the withdrawal symptoms. Even in long-term pharmacotherapy, the combination of sleep hygiene education and CBT-I should be considered to increase the effectiveness of and satisfaction from the insomnia treatment, and minimize the medication dose.